Potential Project Description for 2010-11


Title: Global Health in Geneva
Domain Expert: Dr. Claudia Stein, Epidemiologist at the World Health Organization

One of the projects we will be working on in Geneva involves the estimation of foodborne disease. Foodborne diseases encompass a wide spectrum of illnesses and are a growing public health problem world-wide. They are the result of ingestion of contaminated food stuffs, and range from diseases caused by a multitude of microorganisms to those caused by chemical hazards. The contamination of food may occur at any stage in the process from food production to preparation ('farm to fork') and result from environmental contamination, including pollution of water, soil and/or air. It is for this reason that this burden of disease work is coordinated with other WHO activities in this area, including those on chemicals, water, sanitation and hygiene. (http://www.who.int/foodborne_disease/burden/en/)

The most common clinical presentation of foodborne diseases takes the form of gastrointestinal symptoms but such diseases can also include neurological, gynaecological, immunological and other symptoms. Multi-organ failure and even cancers may result from the ingestion of contaminated food stuffs, thus carrying a considerable disability as well as mortality burden. Surveillance data from developed countries and sentinel sites indicate a high disease burden for foodborne diseases caused by microorganisms alone. Surveillance data, however, tend to show only the tip of the clinical iceberg and cannot sufficiently describe true disease burden. For affected persons to feature in such health statistics, they not only have to seek medical care, provide a specimen for laboratory investigation, and test positive on laboratory methods but also be reported to the relevant health authorities.

To circumvent the problems posed by such under-reporting and describe disease burden more adequately, a number of innovative and creative approaches have been used in recent years for some foodborne diseases from various causes. These include the use of active surveillance and field studies, risk assessment methods, and epidemiological disease modelling. For other foodborne diseases, however, including some zoonoses and diseases cause by chemical hazards, no such data or studies exist.

In order to estimate disease burden adequately and provide comprehensive information for policy makers it is important to move beyond the mere quantification of morbidity and mortality and describe burden in a summary measure that includes elements of severity and duration of disease, as well as resulting disability. One such summary indicator is the Disability Adjusted Life Year (DALY) which has been widely used by WHO and others in the field of burden of disease estimation.